Is it really post-irradiation morphea or oleoma of the breast?-A case report and literature review

Abstract

We report the case of a 65-year-old woman who underwent breast-conserving surgery (BCS) and radiotherapy for breast cancer with hyperpigmentation and skin thickening of the treated breast site 10 years after the surgery. The patient was injected with a liquid foreign body in both breasts 30 years ago. Theses clinical features were considered scleroderma, post-irradiation morphea (PIM), and recurrent breast cancer for differential diagnosis. We performed breast magnetic resonance imaging (MRI), however, the patient had no abnormal findings. Owing to the pain, increased hyperpigmentation, and possibility of cancer recurrence, the patient underwent a simple mastectomy. The final pathologic diagnosis was oleoma with post-radiation fibrosis among drug-induced and toxic scleroderma-like disorders. The patient tolerated surgical therapy without complications. This case report highlight is that difficult to distinguish between PIM and oleoma in patients with a complex history. In this case, the patient had both a history of radiotherapy and a history of foreign body injection, making the clinical diagnosis difficult. PIM and oleoma are non-malignant but can impair a patient's quality of life owing to symptoms and the clinical presentation is similar to that of local recurrence of breast cancer. Thus, arriving at the correct diagnosis typically requires a multidisciplinary approach, including imaging follow-up, skin punch biopsy, or surgery for a definitive diagnosis.